A Spoonful of Knowledge Helps the Medicine Go Down


The average senior takes five prescription medications per day and fills between 9 – 13 prescriptions each year. That is a startling number of pill bottles lining the typical seniors’ counter, each one representing an opportunity for a mistake to be made.

Older adults may struggle to remember to take the proper medicine at the correct time; they may have been prescribed medications that could potentially cause dangerous interactions when taken together; or they may be unable to fill all of their prescriptions because of the high cost of drugs or lack of access to a pharmacy. Any of these issues could have an impact on medication adherence.

Medication adherence is the terminology health professionals use to describe the act of taking medications correctly. Medication adherence is influenced by a patient’s ability to get his or her prescriptions filled, remembering to take the medication on time, and understanding the doctor’s instructions.

Lack of adherence may account for up to 50 percent of treatment failures, an estimated 125,000 deaths, and up to 25% of hospitalizations each year in the United States. It is estimated that chronically ill patients’ medication adherence is only about 50 percent, which leaves hundreds of thousands of adults at risk.

Medication reconciliation is an important function that can help prevent medication errors such as duplication, dosing errors or drug interactions. Medication reconciliation should be done at every encounter with a health care provider, whether in the doctor’s office, a hospital or other inpatient setting. It involves comparing a patient’s medication orders to all of the medications that the patient has been taking.

As caregivers and patients we play an important role in safeguarding our own safety when it comes to medication use. Here are a few steps you can take to help avoid a dangerous medication error:

  • Only use one pharmacy for all your medications and ask the pharmacist any questions you may have regarding how and when to take your medication.
  • If possible, use an independent pharmacist. They tend to be smaller and may offer more personalized services such as coming to the home to fill pill boxes or providing blister packs for easier medication management and adherence.
  • Ask if it is possible to receive a larger supply of medication so that you can make pharmacy visits less often.
  • Have your own medication list and update it as things change. It should include the date, prescription name, dosage, what the medication is treating, when you take it and who prescribed it.
  • Ask a caregiver or friend to act as your medication manager to make sure your medication list is available and updated and to act as your liaison with the pharmacist.
  • If you are discharged from a hospital always ask for a list of medications and review the list before leaving the hospital. Ask which prescriptions you should continue to take, which you should discontinue, and compare that list to the list of medicines you were taking before hospitalization. Ask if should go back to taking anything you were taking prior to hospitalization or if you should discontinue any of your previous medications. Take the new list to your pharmacist. Again, ask questions.

Cost of Medications

It’s Medicare enrollment time which means it is time to review the Medicare Prescription Drug Plans (Medicare Part D) to make sure you choose the right plan for you. Medicare Part D rules are changing in 2020.  Under the new rules, medications may be covered only when prescribed for certain conditions, or there may be higher co-pays depending upon the condition for which the drug is prescribed.  That’s why this year more than ever, it is important to do your homework and don’t get stuck with a plan that does not cover your medication when it is prescribed for your specific condition.

Here is what you can do to pick the right plan for you

  • Go to mymedicare.gov and create an account to find out what coverage will be best for you.
  • Contact the Health Insurance Information and Assistance Program HIICAP for free assistance finding Medicare Plans, or Medicare Rights National Consumer Helpline (800-333-4114) with any questions
  • Contact Care Answered and we can help you find a Medicare specialist/broker at no cost to you.
  • If you find that a plan covers many but not all your meds you may ask for a 90-day supply as a “transition dose” so you can delay the new increased drug price

If you can’t afford your medications, visit the website of the drug manufacturer. Many of them offer patient assistance programs. You can also look for financial assistance on the following websites:





Stay on your feet this fall

Medical alarm and protection company LifeCall made the catch phrase “I’ve fallen, and I can’t get up” part of our popular culture and the punchline of many jokes. But the reality is that falls by seniors that result in injury are nothing to laugh at. Many occupants of nursing homes spend their last days bedridden and immobile due to a series of events resulting from a fall in their home.  A broken hip or other serious injury in an aging body incapable of fully healing is the surest way to go from a life of enjoyable independence to total reliance on others to complete basic life activities.

“Child proofing” is a top priority for new parents intent on preventing injuries to their rambunctious and curious toddlers.  Half a century later, those children, now middle aged, may be required to return the favor, and “senior proof” their parents’ homes.

Here are a few tips to make the home safe and reduce the risk of falls:

  • Get rid of area rugs! According to The Journal of the Royal Society of Medicine, most falls occur on flat surfaces.
  • Install grab handles in the shower and additional railings on stairs.
  • Keep floors clear of clutter, extension cords, and unnecessary furniture.
  • Install higher wattage bulbs and/or more light fixtures and switches to ensure that seniors with diminished eyesight can navigate safely.
  • Place commonly used items within reach so as not to require stretching, balancing, or the use of a step ladder.

An online search for “assisting devices for the elderly” will provide a long list of safety items, convenience items, and services.  Since the risk of falling can be reduced, but not completely prevented, a medical alert system is mandatory.  Sadly, half of all seniors who spend hours on the floor after a fall die within six months, according to the Journal of the Royal Society of Medicine.

The two main contributing factors in falls are failing eyesight and difficulty with balance which is often related to medications. Take these simple precautions to make your home a fall-free zone! For additional tips or assistance with any aspect of aging and health, give me a call at 516-584-2007.

Disaster Planning for Those with Special Needs

News reports filled with heartbreaking images of the devastation wreaked by Hurricane Dorian on the Bahamas are still fresh in many of our minds. While Long Island is frequently spared from the damage of such severe storms, we still remain vulnerable to natural and man-made disasters. Planning ahead is essential, especially during hurricane season.

For most, an emergency plan involves stocking up on milk, water, bread and extra batteries for the flashlight. Depending on the severity of the situation, packing up a few necessities, the kids, and the pets and driving to a safer location might be required. This is a luxury reserved for the able-bodied, but what if you are elderly and/or disabled? What if you have medical equipment that requires electricity? How do you evacuate if the elevator becomes inoperable? Assuming you get to the ground floor, who transports you to safety? Will there be food for your service animal?

For those with special needs, an emergency kit will vary depending on the nature of a disability, but might include extra batteries for hearing aids, a collapsible manual wheel chair, a list of caregivers and phone numbers in a sealed plastic baggie, enough medications for a week, catheters, a portable oxygen tank, a few cans of dog food, information in braille, snacks compatible with dietary restrictions, etc.

A generator, for many, is merely a luxury which would keep the refrigerator cold and the TV on. For others who rely on electrically powered medical equipment, a generator is a necessity. There are government funded programs to address this. FEMA has a generator reimbursement program for this purpose. See: https://www.fema.gov/media-library/assets/documents/94768

There are also many federal, state, and local registries for the disabled which notify first responders and help them locate those who might not be able to evacuate on their own.

An excellent resource for the disabled can be found on FEMA’s website,


Although the elderly and disabled are disproportionately endangered and affected by natural and man-made disasters, effective planning and knowledge of resources can help to avoid tragedies.

Need help with planning for those with special needs? Call me! (516) 584-2007.


Put Your Own Oxygen Mask on First…Even if You Never Fly



All of our lives we have been taught the importance of working hard and taking care of others, but it is equally important to make time to take care of ourselves. On an airplane, flight attendants remind us during the safety drill to put our own oxygen masks on first before assisting others with theirs. That is what self-care is all about. If we don’t put on our own oxygen mask first – figuratively speaking, of course – then we will not be able to take care of the others who depend on us.

And there are so many depending on us! If you are part of the so-called “sandwich generation,” you may be taking care of aging parents or other relatives while still raising young children or teens. For you, August is consumed by a to-do list. I encourage you to start thinking about annual school physicals, making sure that your school-aged children are up to date on their vaccines and check-ups. If you are the parent of a young adult heading off to college or beyond, I urge you to have your son or daughter complete a Health Care Proxy so that you are able to speak with doctors and make medical decisions on their behalf should the need arise. (See my earlier blog post on this topic.)

But most importantly, make sure that you are taking care of yourself. Don’t skip your own annual check-ups. Make sure you undergo the recommended age-based health screenings such as colonoscopy, mammography, osteoporosis screening, and others. Follow up on any red flags that are found during your physical. Get enough rest, drink enough fluids (but limit your alcohol intake), and try to get some exercise every day.

It isn’t always easy to do! Remember when summertime meant long, lazy days, when the pace seemed to slow down both at work and at home, when families scheduled vacations and spent weeks at the shore or in the mountains? These days it seems to be more difficult to take time for ourselves.

This month, Care Answered will be taking our own advice. Our office will be closed from August 12 until August 26. Our staff will be taking a breather to relax, re-set, and reconnect with family and friends. I hope you have an opportunity to do the same this summer, even if it is just for a short spell. Time away is a great opportunity to put your own oxygen mask on first to ensure that you are fully able to take care of all those you love.

Enjoy the rest of the summer!



No Holiday from Good Health

Happy summer! I hope that you enjoyed all that June and early July had to offer…Father’s Day, graduations, Fourth of July celebrations and more! With summer in full swing, you may be thinking about vacation plans and relaxing with friends and family. But please don’t forget to take care of your health this summer.

While there’s never a good time to get sick, it turns out that there are times which are especially bad – namely, any weekend and the entire month of July.

Healthcare veterans all know about the so-called “July Effect.” This phenomenon begins every July 1 in the nation’s teaching hospitals, where men and women who have just graduated from medical school begin their very first weeks of field training. At the same time, more experienced trainees graduate and move on to even more specialized fellowship training programs or private practice.

With their lack of experience, newly minted doctors are more likely to run unnecessary or duplicative tests, may be unfamiliar with hospital pharmacies and prescribing standards, and are more prone to make medical errors. As a result, studies have shown that the death rate in teaching hospitals is significantly higher in July than other months.

A related phenomenon is the so-called “Weekend Effect.” This affects all healthcare settings, including non-teaching hospitals, and is observed all year long. It refers to the fact that many hospitals have fewer expert staff available on weekends and overnight, which coincides with the times when many medical emergencies occur. Numerous studies have shown that patients who visit emergency departments, undergo surgery or experience strokes or other significant episodes on a Saturday are likely to have worse outcomes than patients with similar medical conditions who seek care on other days of the week.

Unfortunately, accidents and illness do not take holidays. While enjoying the summer weather, remember to focus on health and safety to help avoid the need for emergency medical care. Here are a few basic tips to help you stay well:
• Stay hydrated by drinking plenty of water.
• Use sunscreen with an SPF of at least 30, especially if you are out during the warmest part of the day, usually between 11 a.m. and 2 p.m.
• Exercise extra caution around pools and water. Never leave a child unattended around water, even for a few seconds.
• Do not leave children or pets inside parked vehicles, even for a few minutes. The interior of a parked car can become dangerously hot very quickly.

Of course, in a medical emergency, there is not much that you can do to avoid either the July Effect or the Weekend Effect. But there are steps you can take to safeguard your health.
• Avoid scheduling elective surgery or procedures in July. Instead, postpone elective procedures until the fall if it is safe for you to do so.
• Hire a health care advocate. If you must undergo medical treatment over the summer, having an advocate by your side may help ensure that you receive safe, appropriate care.
• If you are unable to hire an advocate, ask a trusted friend or family member to stay with you if you are hospitalized over the summer. Make sure this person writes down the names of all of your medications, tests and procedures and keeps track of the staff who are providing your care.

If you have any questions, give me a call! I’d be happy to talk to you about your healthcare needs or upcoming medical encounters. I can be reached at (516) 584-2007.

Is Technology in Healthcare Your Friend or Foe?

I recently attended a panel discussion centered on the patient experience. At this event, sponsored by New York City Health Business Leaders, leaders from the healthcare technology sector shared their perspectives on whether technological breakthroughs are helping to put the focus on patients and their experience with the healthcare system.

The truth is that sometimes, technology can be dehumanizing. The electronic medical record, which holds the promise to make your medical information shareable and available to your doctors wherever you happen to be receiving care, is a prime example. Where once a doctor’s visit was exclusively dependent on face-to-face communication, oftentimes today the doctor is focused on entering data into a computer during the appointment, reducing the amount of time spent engaging with you, the patient.

However, the panelists, who represented companies that are true healthcare innovators, were optimistic about the potential of technology to help make healthcare more personalized. Apps that can track your needs and “remember” information about you, provide you with education about your health and wellness, and enhance your access to healthcare providers and medications certainly help improve your experience as a patient.

Ultimately we all need to remember that healthcare is about people, not data and statistics, fancy diagnostic equipment or cool apps. The goal of everyone working as part of a healthcare team should be to ensure that each individual is living at their fullest potential, has access to preventive care when they are well and medical treatment when they are sick, and that care is affordable.

Whether technology furthers those goals or simply adds another layer of complexity to an already complex healthcare system remains to be seen. But like the panelists who shared their expertise recently, I’m optimistic that technology has tremendous potential to bring us closer to that ideal.

Patient Advocate Tip:

Whether you are a patient or a caregiver, I recommend that you regularly access your health portals. Ask your doctors if they have them. Many of the portals allow you to message your doctor and get a quick response.  It’s just another tool in accessing your best care (along with your trusty health notebook and copies of your past medical records of course). Questions? I’m here to help. Call me at (516) 584-2007 anytime!

It’s Time for Corporate America to Help its Workers with Caregiving


Almost three out of four American workers are juggling some type of caregiving responsibility – either caring for children, aging parents, or a spouse or partner. Yet companies remain unaware of the burden this places on the workforce, and worse, they are doing little to alleviate the stress that caregiving causes their employees. These are among the findings of a study recently published by the Harvard Business School.

The study found a huge disconnect between workers’ experiences and employers’ perceptions. For example, only 24% of employers believe that caregiving affects their workforce’s productivity, while 80% of employees admit that their caregiving responsibilities do in fact interfere with their work performance.

Beyond performance, the study found that caregiving responsibilities also derail careers for workers of all ages. Thirty-two percent of those surveyed said they had left a job because of the demands of caregiving. While the birth or adoption of a child were among the top reasons cited for leaving, one third reported leaving a job to care for an elder, while a quarter said they left a job to care for an ill spouse, partner or other family member.

The cost to business is multifaceted. High turnover, loss of institutional knowledge, absenteeism and presenteeism were among the hidden costs – often difficult to quantify – identified by the study’s authors as consequences of a workforce that struggles with caregiving.

The good news is that employers can help employees effectively manage both their caregiving responsibilities and the demands of their jobs by providing benefits that assist them with their roles as caregivers. We’re not there yet, but the resources are available.

Few employers offer the types of benefits that directly address caregivers’ needs; of those that do, high percentages of employees take advantage of them, according to the survey. Healthcare coordination and advocacy, when offered as part of an employee benefit package, can provide workers with assistance, resources and peace of mind to allow them to focus fully on their jobs while they are at work. Advocates can work with and through Human Resources Departments to offer their services to employees as needed. When the costs of caregiving are considered, it becomes clear that offering access to advocates as an employee benefit is not only an asset to the employee, but it’s also good for the bottom line.

For additional information, please contact me at 516-584-2007 or email nicole@careanswered.com.

Nicole Christensen Earns Board Certified Patient Advocate (BCPA) Certification

Nicole Christensen, owner of Care Answered, has earned the Board Certified Patient Advocate (BCPA) credential. The BCPA designation acknowledges patient advocate professionals who have demonstrated their experience and proficiency in the field of patient advocacy. The BCPA credential is built on ethical standards, professional competencies and best practices for professionals who work in the emerging field of patient advocacy and have taken the steps necessary to become certified.

Christensen started Care Answered, a healthcare coordination and patient advocacy consulting firm, in 2014. A native Long Islander who has lived and worked in both Nassau and Suffolk Counties, as well as NYC, she has more than 15 years’ experience in advocacy for older adults. Christensen earned a Bachelor of Arts degree in Psychology from Baruch College and a Master of Science degree in Urban Affairs from Hunter College. Her career includes serving as Advocacy Director at Emmaus Service for the Aging in Washington, DC; Advocacy Consultant for LiveOn NY; and Director of Food Access at FoodChange, spearheading the focused outreach and advocacy campaign. As the Vice President of Programs and Agency Relations at Island Harvest, she developed and launched the first senior citizen mobile outreach and advocacy program.

In addition to her professional experience, Christensen has had the personal challenge of securing the best possible care for her own family and thus understands how overwhelming and daunting it can seem.

“I call upon both my professional skills and my personal experience to provide every client with effective advocacy,” said Christensen. “Knowing how to navigate the healthcare system, access the benefits to which families are entitled, and obtain the safest, most appropriate care for my clients and their loved ones is so rewarding. My goal is to provide families with peace of mind and often help them save money as they ensure that their loved ones are well-cared for.”

After conducting industry research, the BCPA certification was created to recognize professionals who are committed to ongoing professional development and the attainment of the skills and knowledge necessary to perform their jobs at the highest level. The BCPA credential is also an avenue for employers to recognize and promote professionalism in patient advocacy.

“It is gratifying to have achieved this certification attesting to the knowledge and experience I have amassed during my career,” said Christensen.

For additional information on Care Answered, visit careanswered.com or call (516) 584-2007. To learn more about PACB, visit its website.

You Can’t Take Them with You: April is National Donate Life Month



This month I had to renew my license and once again checked off the box for organ donor.  What a sense of accomplishment with such little effort!  Will you join me?

The Need

About 114,000 Americans – roughly the population of Ann Arbor, Michigan – are awaiting a life-saving organ transplant. Every day, 20 people on that list die waiting, while another person is added every ten minutes.

Deciding to become an organ donor is a simple process that requires registration with your state. In New York, you can easily register to become an organ donor when you renew your license or non-driver identification card with the Department of Motor Vehicles (DMV). While New York is home to 10 percent of all Americans awaiting an organ donation, the state lags the national average for organ donors, with only 29% of eligible adults enrolled in the registry compared to 51% who have registered nationwide.

Anyone aged 16 and over can join the New York State Organ Donor Registry, and there is no upper age limit for potential donors. In fact, the oldest organ donor in the U.S. was 93. Donor suitability is based solely on the donor’s medical condition and history. Organs that may be donated to help save a life include the heart, lungs, kidneys, liver, and intestines. Corneas may be donated to help restore sight. Tissue donation may be used to replace bone, cartilage and ligaments damaged by disease or injury.

One single organ donor can save up to eight lives and benefit 75 other patients who are in need of donor tissue.

Overcoming Objections

There are many reasons why people shy away from enrolling in the donor registry. Some worry that being an organ donor is against their religion. In reality, all major faiths support organ donation. You can read more about your faith’s position on organ donation here.

Others may be concerned that organ donation will disfigure the body or preclude an open casket funeral service. This is not the case; organ donors may still have an open casket as there is no visible evidence of organ donation on the donor’s body.

Some people question whether their decision to donate organs will impact on their medical care at the end of life. This is not an issue. The organ donor team and the medical treatment team are separate. Every effort is made to save the life of the organ donor. Only when those efforts have been exhausted is the organ donation team notified of the potential availability of organs for a recipient on the waiting list.

April is National Donate Life Month, an annual campaign designed to increase awareness of the dire need for organ donors and to dispel myths surrounding organ donation. As Spring makes a return across our region, it’s natural to think about rebirth and new life. Why not take a moment this month to help another person by making the ultimate gift of life: become an organ donor.

Learn more about becoming an organ donor in New York State.

When the Caregiver Needs Care, You Need an Advocate



Rick Pantuliano lives with his wife and two daughters just a short drive away from his parents’ Nassau County home. This proximity has allowed them to maintain a close relationship with his 77-year-old mother. Yet even though he is nearby, he still needed professional help when his mother’s dementia became significant enough that she required round-the-clock care.

“It got to a point where my mom needed to go on Medicaid,” Rick said. “Applying was a confusing process. I was pulling my hair out.”

His attorney recommended that he contact Nicole Christensen of Care Answered.

“She held my hand through the entire process,” he recalled. “She helped me understand every step of a very time consuming and complicated situation.”

Describing his mom, Raffaela, as a strong woman who was traditionally the caregiver for other family members, Rick related how she began to show signs of dementia about six years ago, six years after his father passed away from emphysema.

“She took care of her sick aunt, who died of cancer. Then she cared for her uncle who passed away of old age. She took care of her own mom and dad who lived with them for years. She took care of a lot of people,” Rick said. “Now it’s her turn, and there’s nobody there but me.”

Commuting from Long Island each day to his job in New Jersey keeps him away for long hours, adding to the stress of trying to ensure that his mom’s needs were being met. Nicole’s assistance helped Rick feel confident that he was arranging for the most appropriate care possible for his mom.

“I would still be at the starting line if it wasn’t for Nicole,” he noted. “She was my advocate. She walked me through the entire process and stepped in whenever I felt I was hitting a brick wall. She translated everything and made it understandable and easy.”

More importantly, Nicole’s intervention will ultimately save the family a significant amount of money. With her help, Rick was able to access funding to pay for live-in aides for his mom – services for which he had been paying out of pocket each month.

Rick worked with Nicole for about five months. She brought him to a point where he has a much better understanding of how the system works and feels empowered to handle the hurdles he faces. She reassured him recently by saying, “You got this,” when he was confronted with yet another form to fill out.

And he agrees. “I am basically comfortable with everything at this point,” he said.

His mom is living safely at home with 24-hour aides. Rick is thankful for the ongoing support of his wife and daughters, and for Nicole’s intervention when he needed her expertise most.

“I would highly recommend Nicole to anybody,” he said. “Unless you’re home 24 hours a day and don’t have a job and understand the ins and outs of the healthcare system, you absolutely need an advocate. Nicole is a wonderful person. She is very caring, very in tune to your needs, and she just does her job very, very well.”